PICCO在重型颅脑损伤患者容量管理中的临床应用价值研究

Clinical Significances of PICCO Monitoring in the Capacity Management of Patients with Severe Craniocerebral Injury

目的:探讨脉搏指数连续心输出量(PICCO)技术在重型颅脑损伤患者液体管理中的临床应用价值。方法:回顾性分析重型颅脑损伤患者46例(男性27例,女性19例),以应用PICCO技术监测血流动力学指标指导液体管理的患者为治疗组(n=26),未应用PICCO技术指导液体管理的患者为对照组(n=20)。比较两组患者的日平均液体量、格拉斯哥昏迷评分(GCS)、急性生理与慢性健康评分(APACHE II)、肺水肿发生率、住院时间、住院总费用以及治疗6个月后的格拉斯哥预后评分(GOS)、生存率、颅脑损伤恢复良好率。结果:治疗期间,治疗组的GCS评分以及APACHEII评分均优于对照组,而治疗组的住院总费用高于对照组,但差异并无统计学意义(P>0.05)。治疗组的日平均液体量、肺水肿发生率及住院时间均明显少于对照组,差异有统计学意义(P<0.05)。治疗6个月后,治疗组患者的GOS评分、生存率和颅脑损伤恢复良好率均高于对照组,但差异亦无统计学意义(P>0.05)。结论:应用PICCO技术监测血流动力学指标指导重型颅脑损伤患者的容量管理可在一定程度上缩短危重患者的住院时间并降低肺水肿的发生率,但并不能明显改善患者的预后。

Objective： To investigate the clinical value of pulse index continuous cardiac output （PICCO） monitoring technology in guiding capacity management of patients with severe cranioeerehral injury. Methods： A total of 46 patients with severe craniocerebral injury were retrospectively analyzed in this study （27 cases of male, 19 cases of female）. Patients who were treated with PICCO technology monitoring hemodynamic index to guide liquid management were enrolled in the treatment group （n=26）, while those who were not treated by PICCO monitoring were enrolled in the control group （n=20）. Then the average daily amount of liquid, Glasgow Coma Scale （GCS） score, acute physiology and chronic health evaluation （APACHEⅡ） score, the incidence of pulmonary edema, hospital stay, total expenditure and Glasgow outcome score （GOS）, survival rate, fine rate of recovery after 6 months＇ treatment were compared. Results： During the treatment, the GCS score and APACHEII score in the treatment group were superior to those of the control group, and the total expenditure in treatment group was significantly higher than that of the control group, but no statistical difference was found （P〉0.05）. The average daily amount of liquid, length of hospital stay and the incidence of pulmonary edema in treatment group were significantly shorter or lower than those of the control group （P〈0.05）. Moreover, after 6 months＇ treatment, the survival rate, GOS and free rate of recovery in treatment group were higher than those of the control group, but there was no statistical difference between these groups （P〉0.05）. Conclusion： In clinic, application of PICCO monitoring in guiding capacity management of patients with severe craniocerebral injury could be in a certain extent reduce the length of hospital stay and the incidence of pulmonary, but didn＇t significantly improve the prognosis of patients.